TY - JOUR
T1 - Cost-effectiveness of a Novel Hypoglycaemia Programme
T2 - The 'HARPdoc vs BGAT' RCT
AU - Healey, Andrew
AU - Soukup , Tayana
AU - Sevdalis, Nick
AU - Bakolis, Ioannis
AU - Cross, Samantha
AU - Heller, S
AU - Brooks, Augustin
AU - Kariyawasam, Dulmini
AU - Toschi, Elena
AU - Gonder-Frederick, Linda
AU - Stadler, Marietta
AU - Rogers, Helen
AU - Goldsmith, Kimberley
AU - Choudhary, Pratik
AU - de Zoysa, Nicole
AU - Amiel, Stephanie
N1 - Funding Information:
The HARPdoc trial was funded by the Juvenile Diabetes Research Foundation (4‐SRA‐2017‐255‐M‐N), with additional funding from the National Institute of Health Research (NIHR) through the South London Collaboration for Leadership in Applied Research and Health Care (CLARHC). AH, NS and IB are supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King's College Hospital NHS Foundation Trust. IB is also supported by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust NS is also funded by, and AH is a member of, King's Improvement Science, which offers co‐funding to the NIHR ARC South London and comprises a specialist team of improvement scientists and senior researchers based at King's College London. Its work is funded by King's Health Partners (Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), and Guy's and St Thomas' Charity and the Maudsley Charity (grant number: NIHR200152). MS is funded through an NIHR Clinician Scientist Fellowship (CS‐2017‐17‐023). Infrastructure support for this research for TS was also provided by the NIHR London Medtech and in vitro diagnostic cooperative. The study was sponsored jointly by King's College London (Professor Rezavi, susan. dickson@ kcl. ac. uk) and King's College Hospital NHS Foundation Trust, (Research & Innovation Office, kch‐ tr. research@ nhs. net). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2024 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.
PY - 2024/6/11
Y1 - 2024/6/11
N2 - AIMS: To assess the cost-effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised care), focussed upon cognitions and motivation, versus BGAT (Blood Glucose Awareness Training), focussed on behaviours and education, as adjunctive treatments for treatment-resistant problematic hypoglycaemia in type 1 diabetes, in a randomised controlled trial.METHODS: Eligible adults were randomised to either intervention. Quality of life (QoL, measured using EQ-5D-5L); cost of utilisation of health services (using the adult services utilization schedule, AD-SUS) and of programme implementation and curriculum delivery were measured. A cost-utility analysis was undertaken using quality-adjusted life years (QALYs) as a measure of trial participant outcome and cost-effectiveness was evaluated with reference to the incremental net benefit (INB) of HARPdoc compared to BGAT.RESULTS: Over 24 months mean total cost per participant was £194 lower for HARPdoc compared to BGAT (95% CI: -£2498 to £1942). HARPdoc was associated with a mean incremental gain of 0.067 QALYs/participant over 24 months post-randomisation: an equivalent gain of 24 days in full health. The mean INB of HARPdoc compared to BGAT over 24 months was positive: £1521/participant, indicating comparative cost-effectiveness, with an 85% probability of correctly inferring an INB > 0.CONCLUSIONS: Addressing health cognitions in people with treatment-resistant hypoglycaemia achieved cost-effectiveness compared to an alternative approach through improved QoL and reduced need for medical services, including hospital admissions. Compared to BGAT, HARPdoc offers a cost-effective adjunct to educational and technological solutions for problematic hypoglycaemia.
AB - AIMS: To assess the cost-effectiveness of HARPdoc (Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised care), focussed upon cognitions and motivation, versus BGAT (Blood Glucose Awareness Training), focussed on behaviours and education, as adjunctive treatments for treatment-resistant problematic hypoglycaemia in type 1 diabetes, in a randomised controlled trial.METHODS: Eligible adults were randomised to either intervention. Quality of life (QoL, measured using EQ-5D-5L); cost of utilisation of health services (using the adult services utilization schedule, AD-SUS) and of programme implementation and curriculum delivery were measured. A cost-utility analysis was undertaken using quality-adjusted life years (QALYs) as a measure of trial participant outcome and cost-effectiveness was evaluated with reference to the incremental net benefit (INB) of HARPdoc compared to BGAT.RESULTS: Over 24 months mean total cost per participant was £194 lower for HARPdoc compared to BGAT (95% CI: -£2498 to £1942). HARPdoc was associated with a mean incremental gain of 0.067 QALYs/participant over 24 months post-randomisation: an equivalent gain of 24 days in full health. The mean INB of HARPdoc compared to BGAT over 24 months was positive: £1521/participant, indicating comparative cost-effectiveness, with an 85% probability of correctly inferring an INB > 0.CONCLUSIONS: Addressing health cognitions in people with treatment-resistant hypoglycaemia achieved cost-effectiveness compared to an alternative approach through improved QoL and reduced need for medical services, including hospital admissions. Compared to BGAT, HARPdoc offers a cost-effective adjunct to educational and technological solutions for problematic hypoglycaemia.
UR - http://www.scopus.com/inward/record.url?scp=85186629461&partnerID=8YFLogxK
U2 - 10.1111/dme.15304
DO - 10.1111/dme.15304
M3 - Article
C2 - 38421806
SN - 0742-3071
VL - 41
JO - Diabetic medicine : a journal of the British Diabetic Association
JF - Diabetic medicine : a journal of the British Diabetic Association
IS - 6
M1 - e15304
ER -
